Basic Information
| Provider Information | |||||||||
| NPI: | 1861498537 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STACK | ||||||||
| FirstName: | RAND | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 73 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107107616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146826430 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 73 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107107616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146826430 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 06/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 175062 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 032665 | CT | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.